Get License Renewal Application Form For Medical Imaging Or Radiation ...

Completing the License Renewal Application Form for Medical Imaging or Radiation Therapy is an essential step in maintaining your professional credentials. This guide provides detailed instructions on how to fill out the form online, ensuring a smooth renewal process.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill out Section 1 with your general information, including your unique MIRTP registration number, name, address, phone numbers, email address, and birth date. Ensure all fields are filled correctly.
3. In Section 2, provide information for any active credentialing organizations. Enter your applicable ID numbers and credentials for organizations such as ARDMS, ARMRIT, ARRT, CCI, and NMTCB.
4. Review Section 3 and accurately complete the fee schedule. Include the biennium licensure fee of $110.00 in Box 1, add any costs for additional certificates in Box 2, and if your license has expired, enter the $25.00 reinstatement fee in Box 3. Calculate the total fee for Box 4.
5. In Section 4, decide whether to coordinate your NM license expiration date with your national credentialing organization expiration date, and check the appropriate box if you opt for this.
6. Move to Section 5 to acknowledge various statements by placing a check mark next to each item as you complete them. Ensure that a signed application, payment, and all required documents are included.
7. Ensure that you sign the application form in Section 6, as typed signatures will not be accepted. This signature certifies your compliance with all applicable regulations.
8. Once you've filled out all sections and verified the information, save your changes, download, or print the completed form. After printing, inspect it for accuracy and ensure your signature is present.
9. Mail the completed application packet to the designated address: NMED-MIRTP, Attention: Stephen Sanchez, P.O. Box 5469, Santa Fe, NM 87502-5469. Do not staple the application form or attach payment with tape.

Complete your license renewal application online today to ensure your credentials remain up-to-date.